Reverse total shoulder glenoid component inclination affects glenohumeral kinetics during abduction: a cadaveric study

Knighton, Tyler W.; Chalmers, Peter N.; Sulkar, Hema J.; Aliaj, Klevis; Tashjian, Robert Z.; Henninger, Heath B.

doi:10.1016/j.jse.2022.06.016

Cited by 14 publications

(7 citation statements)

References 44 publications

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“…In addition, consistent biomechanical data support that superior glenosphere inclination is associated with an increase in component impingement during shoulder adduction and greater shear forces, potentially negatively affecting baseplate fixation and implant survival 44,50,51 . In general, the superior inclination of the glenoid component should be avoided in rTSA because of the increased risk of loosening, scapular notching, restricted motion, and instability, especially noted in nonlateralized glenoid components 52-55 .…”

Section: Discussionmentioning

confidence: 80%

The Value of Computer-Assisted Navigation for Glenoid Baseplate Implantation in Reverse Shoulder Arthroplasty

Velasquez Garcia,

Abdo,

Sanchez-Sotelo

et al. 2023

JBJS Reviews

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Background: Glenoid baseplate malpositioning during reverse total shoulder arthroplasty can contribute to perimeter impingement, dislocation, and loosening. Despite advances in preoperative planning, conventional instrumentation may lead to considerable inaccuracy in implant positioning unless patient-specific guides are used. Optical navigation has the potential to improve accuracy and precision when implanting a reverse shoulder arthroplasty baseplate. This systematic review aimed to analyze the most recent evidence on the accuracy and precision of glenoid baseplate positioning using intraoperative navigation and its potential impact on component selection and surgical time. Methods: We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. The PubMed, Scopus, and EMBASE databases were queried in July 2022 to identify all studies that compared navigation vs. conventional instrumentation for reverse shoulder arthroplasty. Data of deviation from the planned baseplate version and inclination, the use of standard or augmented glenoid components, and surgical time were extracted. Quantitative analysis from the included publications was performed using the inverse-variance approach and Mantel-Haenszel method. Results: Of the 2,048 records identified in the initial query, only 10 articles met the inclusion and exclusion criteria, comprising 667 shoulders that underwent reverse total shoulder arthroplasty. The pooled mean difference (MD) of the deviation from the planned baseplate position for the clinical studies was −0.44 (95% confidence interval [CI], −3.26; p = 0.76; I2 = 36%) for version and −8.75 (95% CI, −16.83 to −0.68; p = 0.02; I2 = 83%) for inclination, both in favor of navigation. The odds ratio of selecting an augmented glenoid component after preoperative planning and navigation-assisted surgery was 8.09 (95% CI, 3.82-17.14; p < 0.00001; I2 = 60%). The average surgical time was 12 minutes longer in the navigation group (MD 12.46, 95% CI, 5.20-19.72; p = 0.0008; I2 = 71%). Conclusions: Preoperative planning integrated with computer-assisted navigation surgery seems to increase the accuracy and precision of glenoid baseplate inclination compared with the preoperatively planned placement during reverse total shoulder arthroplasty. The surgical time and proportion of augmented glenoid components significantly increase when using navigation. However, the clinical impact of these findings on improving prosthesis longevity, complications, and patient functional outcomes is still unknown. Level of Evidence: Level III, systematic review and meta-analysis. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 80%

The Value of Computer-Assisted Navigation for Glenoid Baseplate Implantation in Reverse Shoulder Arthroplasty

Velasquez Garcia,

Abdo,

Sanchez-Sotelo

et al. 2023

JBJS Reviews

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“…Initially, it was hypothesized that both inferior tilt and superior tilt may impact RoM in this simulation study; however, recent studies have suggested that the superior tilt has many biomechanical disadvantages, such as increased shear forces and reduced compression forces, which may cause loosening [ 26 – 30 ]. Therefore, only the inferior tilt was evaluated.…”

Section: Discussionmentioning

confidence: 99%

Baseplate inferior offset affects shoulder range of motion in reverse shoulder arthroplasty in Asian population

Yamada,

Kozono,

Nabeshima

et al. 2024

J Orthop Surg Res

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Background Impingement is a common complication of reverse shoulder arthroplasty. Placement of the baseplate with a wide impingement-free angle is ideal; however, there are few studies on Asian populations, which have smaller height and physique, and there is a lack of guidance on achieving optimal outcomes. The purpose of the present study was to explore the impingement-free range of motion reverse shoulder arthroplasty and analyze the suitable baseplate position or tilt for the Asian population using simulation software. Methods We uploaded computed tomography scan data from 20 Asian patients to three-dimensional (3D) simulation software. The implantation of the reverse shoulder arthroplasty component was performed on the 3D humerus and scapula using software, and range of motion was assessed until impingement occurred. Results The range of motion in flexion significantly improved when the baseplate was lowered up to 3 mm inferiorly. Range of motion in abduction and internal and external rotation significantly improved as the baseplate was lowered up to 4 mm. There was no significant difference in range of motion in any motion after changing the inferior tilt, except in internal and external rotation. Conclusions The range of motion in abduction, flexion, and internal and external rotations significantly improved with increased inferior offset. These results may prove valuable in determining the optimal baseplate position for RSA, particularly in Asian populations.

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“…Given most rTSA baseplates occupy only the inferior portion of the glenoid fossa, the RSA angle is believed to more accurately measure the inclination of the glenoid fossa most pertinent to the rTSA baseplate 63 . Inferior glenoid inclination is generally advocated as a way to reduce shear forces at the bone-implant interface, which has been shown through biomechanical and computer-based models [64][65][66] . In addition to the benefit of reduction of shear forces, an inferior glenoid tilt has been shown to increase the joint compressive forces seen at the implant bone interface, which may be associated with greater bone ingrowth and greater implant stability 64 .…”

Section: Inclinationmentioning

confidence: 99%

“…Given most rTSA baseplates occupy only the inferior portion of the glenoid fossa, the RSA angle is believed to more accurately measure the inclination of the glenoid fossa most pertinent to the rTSA baseplate 63 . Inferior glenoid inclination is generally advocated as a way to reduce shear forces at the bone-implant interface, which has been shown through biomechanical and computer-based models 64-66 . In addition to the benefit of reduction of shear forces, an inferior glenoid tilt has been shown to increase the joint compressive forces seen at the implant bone interface, which may be associated with greater bone ingrowth and greater implant stability 64 .…”

Section: Glenoid Factorsmentioning

confidence: 99%

The Influence of Component Design and Positioning on Soft-Tissue Tensioning and Complications in Reverse Total Shoulder Arthroplasty

Haase,

Ina,

Harlow

et al. 2024

JBJS Reviews

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» Reverse total shoulder arthroplasty was designed to function in the rotator cuff deficient shoulder by adjusting the glenohumeral center of rotation (COR) to maximize deltoid function.» Adjustments in the COR ultimately lead to changes in resting tension of the deltoid and remaining rotator cuff, which can affect implant stability and risk of stress fracture.» Soft-tissue balance and complication profiles can be affected by humeral component (version, neck shaft angle, and inlay vs. onlay) and glenoid component (sagittal placement, version, inclination, and lateralization) design and application.» A good understanding of the effects on soft-tissue balance and complication profile is critical for surgeons to best provide optimal patient outcomes.

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Reverse total shoulder glenoid component inclination affects glenohumeral kinetics during abduction: a cadaveric study

Cited by 14 publications

References 44 publications

The Value of Computer-Assisted Navigation for Glenoid Baseplate Implantation in Reverse Shoulder Arthroplasty

The Value of Computer-Assisted Navigation for Glenoid Baseplate Implantation in Reverse Shoulder Arthroplasty

Baseplate inferior offset affects shoulder range of motion in reverse shoulder arthroplasty in Asian population

The Influence of Component Design and Positioning on Soft-Tissue Tensioning and Complications in Reverse Total Shoulder Arthroplasty

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